[image quote]: "I've recently come to realize that I can't be some untouchable, unattainable version of recovery that can only depend on helping others and say, 'Well I'm helping others, and that's going to be my mental healthcare treatment,' and that's not how it is. I had to be honest with myself. I have to prioritize my self-care." - Dior, episode 12; Major Depressive Disorder patient

[image quote]: "I've recently come to realize that I can't be some untouchable, unattainable version of recovery that can only depend on helping others and say, 'Well I'm helping others, and that's going to be my mental healthcare treatment,' and that's not how it is. I had to be honest with myself. I have to prioritize my self-care." - Dior, episode 12; Major Depressive Disorder patient

CW: Suicide
12 A Festive Holiday Episode About Depression (episode page)
Description: On this week’s episode, Cara talks to Dior Vargas, Latina feminist mental health activist, about her experiences with depression, suicide rates, and her People of Color with Mental Illness photo project. In honor of Festivus, Cara airs some grievances about medication and its place in our culture, and the false division between mental illness and physical illness. She talks about the Feats of Strength required to make it through the holiday while living with chronic illness, and they discuss getting help, media representation, and how Dior got invited to the White House.

[intro]

Hey there and welcome you to In Sickness + In Health—a podcast about chronic illness, disability, medical traumas, and everyday uncomfortable healthcare experiences. My name is Cara Gael; I’m not a doctor or medical professional, I’m just a person and a patient who really wants to talk about this stuff more.

If you’re new to the show, welcome! Nothing said on this show should be considered medical advice. If you’re experiencing a medical issue, please seek qualified medical help. I know the system sucks, but I wish you a lot of luck. Every person is different, even within disease groups, so none of my guests should be regarded as official representatives or spokespersons for their conditions. Please respect their very personal choices, and unless they ask for it, please don’t make suggestions about treatments or lifestyle changes. As will come up again and again on this show, unsolicited medical advice is almost never not annoying.

If you’re listening to this the day it comes out, tomorrow will be Festivus! It’s actually a totally made up holiday, even moreso than all the others, because it originated from an episode of Seinfeld, but it’s my favorite holiday! It’s a secular celebration that is a playful alternative to the commercialization of Christmas. A Festivus for the Rest of Us is the perfect holiday for the chronically ill and/or depressed. It entails an unadorned aluminum pole as an alternative to a tree, and rituals such as the Airing of Grievances and Feats of Strength.

The holiday season is full of feats of strength, especially for those of us that live with chronic health conditions: dealing with stressful family situations, strained finances, travel logistics, enforced merriment, shortened days and shitty weather…with chronic illness, these things are all 10x harder, so don’t feel bad if you’re not feeling so merry and bright this season. It’s no wonder that many people experience depression at this time of year; whether it’s an exacerbation of year-round clinical depression, or seasonal, it can really make the holidays difficult. And so, I thought it would be most appropriate to make this week’s episode a festive holiday one about depression!

I talked to Dior Vargas, Latina feminist mental health activist, about her experiences with depression, suicide rates, and her People of Color with Mental Illness photo project. We talk about getting help, media representation, and how she got invited to the White House.

We’ll be talking about some touchy issues like taking medication, suicide, and racism. If these topics are at triggering for you, you’re currently in crisis or know someone who is, please contact the National Suicide Prevention Lifeline at 1-800-273-8255, or find other more specific mental health resources linked to in the show notes. I’ve also included other resources about the different types of depressive disorders, different types of antidepressants, different types of therapy, and how to go about finding a therapist that’s right for you. There are also some links to the work of Jennifer Michael Hecht, who has experienced suicidal ideation herself, lost friends to suicide, and since written extensively on the topic. Her recent episode of On Being is one of my favorites, and in it she reads her poem, “No Hemlock Rock,” which ends:

"Stay. Thank
you for staying. Please stay. You
are my hero for staying. I know
about it, and am grateful you stay.
Eat a donut. Rhyme opus with lotus.
Rope is bogus, psychosis. Stay.
Hocus Pocus. Hocus Pocus.
Try not to kill yourself. I won't either.”

It is a common misconception that suicide rates spike around the holidays. Those rates are generally highest in the late spring and early summer, but like I talked about before, depression definitely intensifies around the holidays. In this episode we talk about suicide rates as they break out among ethnic and age groups, but there are other groups with alarmingly high rates of suicide attempts and completions. For example, 41% of transgender and gender non-conforming people have attempted suicide, compared to a national average of just 4.6%—and I hope to devote a whole episode to that in the near future.
 
This Festivus, I’ll start the airing of my grievances with what I often hear when people talk about mental illness: “what if people treated physical illness like mental illness,” the implication being that they are somehow regarded differently by people, that physical illness is taken more seriously, free from stigma, judgement, and ableism. While that may be true with acute illness like the flu or something like cancer, invisible and chronic illnesses are actually treated in the exact same way: people don’t take them seriously, people don’t believe in them, people judge them harshly, stigmatize them, and offer ridiculous, insensitive and ineffectual cures that are nothing but offensive. Mental illness and physical illness happen in the same body, and it’s kind of silly to me that we make such a big deal about there being a big difference between them at all; I see very little difference, and think they should both be taken seriously, and they both need better treatment and more research. If nothing else, we should never stand on top of one group while trying to make a point for another. Illness, be it mental or physical, sucks, and we should all be taking them a lot more seriously.

The other grievance that I’ll air is about how frustrating it is that so many people are so vehemently anti-medication. If you feel it just isn’t for you, that’s totally fine, but I hear a lot of people discouraging others from taking it, talk very negatively about the risks of medication, and how Big Pharma is just inventing reasons to line their pockets and pour pills down our throats. While some of that may be true, it always makes me so mad! It makes me mad because myself, many people I love, and MILLIONS of others get their lives saved on a daily basis by pharmaceuticals. Whether it’s preventing a medical condition from killing you outright, or taming your depression enough that you don’t want to kill yourself, medication is a very important part of managing many medical conditions. And it’s really very alienating and further stigmatizing to get that anti pharma rhetoric shoved in our faces so often. Therapy is also super important, but there is a biological basis to depression that we can’t necessarily think or talk our way out of, though many will try to convince you otherwise. It is because of this stigma that most people never seek treatment at all for depressive disorders.

As Dior points out in the interview, a lot of people are resistant to the idea of taking medication to treat their depression, and often economic issues get in the way of getting treatment. It’s not for everyone, and not everyone has access to adequate and ongoing mental health treatment, but for many people, antidepressants are an essential part of their existence. I can recommend Cara Santa Maria’s episode of the podcast, The Dark Place, if you want to better understand the chemical side of depression, why some people are so resistant to getting help, and what therapy and the right medication has done for her.

Antidepressants are super important, and I am a big fan of their work, but let’s be real: people don't talk much about how hard it can be to find the right medication, and I’m not going to act like it isn’t bananas that some antidepressants for some people may actually make them want to kill themselves. Not talking about that part isn’t particularly helpful for anyone. The black box warning on antidepressants about increased risk of suicide in adolescents and young adults is some scary shit, but as with any medication, we weigh the risks and benefits of treatment.

I’ve had a pretty hard time with antidepressants myself, I’ve lived the nightmare of feeling like i’ve lost control over my brain with multiple drugs. Unfortunately, until we have a noninvasive test that is able to measure what what’s going on in our brains neurotransmitter-wise, and what kind of treatment or combination of treatments might be most effective, trial and error is all we have. I’m not telling you this stuff to freak you out or warn you away from taking antidepressants if you need them. I’m telling you this so that you know you’re not alone or extra broken if you’ve had a hard time with this, so you know that struggling with medication is totally normal, and so that you know there is at least a little hope.

After some pretty terrible experiences with multiple SSRI’s, which are the most common type of antidepressant, I thought antidepressants just weren’t for me. Then a doctor put me on a very low dose of an antidepressant different class to treat migraines. It didn’t really do much for the headaches, but after a few week adjustment period, I suddenly, finally understood what antidepressants were supposed to do. I have been so much better able to keep my head above water, and when I do get upset, those waters are so much more shallow. My emotions aren’t blunted, I’m not a different person, I am still able to experience joy and sorrow and everything in between, and feel like I’ve actually been much better equipped to deal with life and grow into myself.

But my work in this area is not done. I recently added a different antidepressant in yet another class to my regimen to help with my centralized pain issues, and it hasn’t gone quite as well. It’s still early, and it may still work for me, I need to give it a little more time, but I’m having a rough go of it. I almost didn’t mention this part, but I decided to include it because new medications are still scary for me too. They are something I’m always going to have a hard time with, but it’s important to me that you know I keep trying.

This isn’t to say that the same approach will work for you, it probably won't. As with health in general there are so many factors that go into shaping our response to medication. It’s a learning process, and for me, there’s been a lot of confusion and failure during that process. Your process will be different because it will be your own. I’m not going to lie to you, it can be scary, it definitely hasn’t solved all my problems, and sometimes even the right drug will give you a hell of a time in the beginning. But your life is worth giving it a try--if you can and if it’s the right time for you. And it may not be, but so many people lose years of their lives because they are afraid to take medication, or because they had a bad experience with one or two drugs and have concluded that they are beyond help, or that they are not bad enough to need treatment, or that if they just eat a super restrictive diet and exercise constantly they can cure themselves, or that they don’t want to take a pill every day. I thought all of those things at one time or another.

It’s also totally okay if you’re not ready, but there are a ton of options waiting for you when you are.

So even if your holidays are not merry and bright, I hope you’ll hang in there with us. On top of the mental health resources I’ll have in the show notes, Ill also include some links to further reading and listening about depression and suicide. I know it really helps me to know that I’m not alone in feeling down, and so I hope it will help you as well.

I hope you enjoy this episode and find more from us at insicknesspod.com and @insicknesspod on social media. You can find more from Dior Vargas, including her People of Color with Mental Illness photo project at diorvargas.com, and I hope your holidays will at least be filled with some coziness and naps, if nothing else.

[interview]

And thank you so much for listening to this episode of In Sickness + In Health. If you are contemplating suicide or worried about someone who might be, please contact the National Suicide Prevention Lifeline at 1800-273-8255, or find other resources linked to in the show notes. You can find more from us at in sicknesspod.com, on social media @insicknesspod, and more from Dior Vargas, including her POC w Mental Illness photo project at diorvargas.com. Please rate and review us on iTunes, it helps other people find the show.

And don’t forget to be excellent to yourself and each other.